Effectiveness of Training Non-Specialist Health Workers for the Management of Substance Use Disorders: A Systematic Review and Meta-Analysis.

ISSUES: Substance use disorders (SUD) pose a global health challenge, especially in resource-limited settings. Training non-specialist health workers (NSHW) is a promising task-sharing strategy. This systematic review assessed the effectiveness of such training in improving NSHWs' knowledge, attitudes, self-efficacy and practice.

APPROACH: We searched PubMed, SCOPUS and EMBASE and included randomised controlled trials (RCT), quasi-experimental and pre-post studies published between 1 January 2008 and 30 October 2024. Data were synthesised using effect sizes reported as standardised mean differences (SMD). Risk of bias assessments included Cochrane Risk of Bias 2.0 (RoB2) for RCTs and the Newcastle-Ottawa Scale for observational studies.

KEY FINDINGS: Of 21,892 records, 29 studies were included: RCTs (n = 7), quasi-experimental (n = 4) and pre-post studies (n = 18). Training formats ranged from 30-min sessions to two-year programs, using hybrid approaches with didactics, role-plays and simulations. Content included SBIRT (n = 8), motivational interviewing (n = 5), and management of alcohol, opioid and tobacco use. The pooled analyses of RCTs showed significant short-term changes to NSHW's knowledge [SMD 0.59 (95% CI 0.40, 0.79)], self-efficacy [SMD 0.45 (95% CI 0.26, 0.64)] and practice [SMD 0.24 (95% CI 0.03, 0.46)]. Pooled analysis from RCTs for changing attitude showed a non-significant result. Quality was mixed: most (4/7) RCTs raised some concerns, and observational studies were mostly moderate (6/13), with frequent reliance on self-report, limited confounding control and short follow-up.

IMPLICATIONS AND

CONCLUSION

Training NSHWs has modest effects on knowledge and self-efficacy and small effects on the practice of SUD management.